The healthcare sector is continuously evolving, but recent events such as the COVID-19 pandemic, an explosion in digital health solutions, and new transparency regulations have accelerated the pace of change even further — and will likely continue to do so for the foreseeable future.
Here are five healthcare trend predictions to monitor in 2021 (and beyond).
1. Advancement in Cost and Quality Transparency Regulation
Two new regulations now require health plans and providers to be far more transparent about the price and quality of both care and prescription drugs.
Under the Hospital Price Transparency rule, all U.S. hospitals must publish — and regularly update — clear and comprehensive pricing information online, including all discounted and payer-negotiated rates. It should be easily accessible and not require login credentials or any other sort of authentication process. This will allow Americans to be more informed about the costs of shoppable hospital items or services (i.e., psychotherapy, mammograms, routine labs) before they use them.
The new Transparency in Coverage policy requires non-grandfathered health plans and payers to provide real-time access to relevant pricing details, such as in-network rates, out-of-network charges, prescription drug pricing, and more. Consequently, consumers will be better equipped when making healthcare purchasing decisions.
As a result of these two new regulations, consumers will likely see an increase of consumer-friendly price transparency tools and experiences. In addition, in an effort to go beyond simply adhering to regulations, some organizations may create new, innovative ways to deliver transparency, given access to unprecedented levels of cost information.
2. An Increase in Data Interoperability
As two new interoperability rules are implemented, the sharing of healthcare data will gradually standardize and become more API-based in an effort to adhere to FHIR (Fast Healthcare Interoperability Resources) specifications.
The Centers for Medicare & Medicaid Services’ Interoperability and Patient Access rule will allow patients to access their personal health information (PHI). Historically, the healthcare industry’s lack of seamless data exchange has detracted from patient care and resulted in poor health outcomes and higher costs. With this rule, data will flow more freely (but still securely), enabling both patients and providers to be better informed and ultimately leading to better coordinated care, reduced costs, and improved health outcomes.
The Cures Act Final Rule, instated by the Office of the National Coordinator for Health Information Technology, is designed to supply patients (and their providers) with free and secure access to their PHI, which they should be able to easily access from apps on their smartphones.
Expect to see an increase in innovation and competition as third-party companies start to build new strategies that assume greater data interoperability with payers and providers. Interoperability also supports the emergence of new care models — like virtual primary care — that thrive when it’s possible to establish a longitudinal patient record.
3. Further Defining of the “Digital Front Door”
Already an industry-wide concept, the digital front door approach aims to connect patients to every major touchpoint of their healthcare journey, leveraging technology the patient already uses on a regular basis. While many different “front doors” have been developed by providers, insurance companies, and various employers, this approach has yet to be perfected.
Throughout 2021, this strategy will continue to be redefined and reimagined by different access channels in order to find the ideal digital front door for healthcare. The increases in both transparency and interoperability will nicely complement these efforts. In addition, the question of, “Who exactly owns the digital front door?” should become more clear.
4. Innovation in Primary Care
The current primary care model — visiting a primary care physician (PCP) once a year, if at all, for a 15-minute checkup — is antiquated. One quarter of the U.S. population doesn’t even have a PCP. In the 30-year-old age group, 36% don’t have a PCP. Even before the COVID-19 pandemic, 46% of adults went at least a year without seeing their PCP.
With that data, you have to wonder, is the current model working? Is it making people healthier, or is it just checking off a box? This area of healthcare is ripe for innovation. Look for primary care delivery to be reimagined in a way that will boost consumer engagement and influence downstream medical spend.
For example, instead of visiting a PCP for just a few minutes annually, perhaps primary care could be continuous throughout the year. The patient could regularly communicate with their PCP via a secure portal that provides video chat, email, and text options, and the PCP could ensure the patient is participating in healthy habits, connected with the necessary specialists, and receiving all the care they need.
As the concept of virtual primary care is further defined in 2021, look for seamless navigation between both digital and traditional in-person care settings to be a key challenge.
5. Continued Consolidation of Digital Health Solutions
Digital health has exploded over the past few years, and there are now so many disparate solutions. The market is starting to realize that certain services and companies should be paired together, such as Livongo (chronic condition management) and Teladoc (virtual care), two companies that merged in October 2020.
It’s highly likely that there will be similar mergers, acquisitions, and partnerships between complementary digital health solutions in an effort to create more scalable healthcare delivery models.
Learn more about how Castlight Health works with health plans.
Jake Fochetta is the director of Corporate Strategy at Castlight Health. An experienced healthcare IT professional, he has spent more than 10 years in enterprise technology strategic planning for hospitals and health systems, operational transformation, patient engagement, and virtual care strategy development.